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r � <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1068 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> NON-REFUN----'�--"'- CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADOREs4 ( 434O _Q_ CInIZIP Stockton r <br /> acon 'a"I Rond a,t� <br /> CROSS STREET Byy� All I CIV•>L 09o10 PARCEL SIZE AM V C, <br /> _ <br /> OWNER NAM n do - Etra LJ�7�$� D)St/i�} fJT lEle�hPHONE 510-719.3470 1171 <br /> D {� p // /� , <br /> OWNER ADDRESS �•� �:TF J y I S"3 CITY/STATE/LP La- An�j�FS <br /> CONTRACTOR W.C.Maloney,Inc. PHONE 209-244-7090 `/ Q <br /> CONTRACTOR ADDRESS Po Box 30326 .._, CITY/STATEfZlP StDckhm.CA 95213 <br /> LICENSE f- C42 0--C-36 OTHER C&21 A NUMBER 718243 EXPIRATION DATE 1/312021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST C BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 'l NEW INSTALLATION REPAIRIAODITON ENGINEER DESIGNED/ALTCRNA,�1 <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION <br /> INSTALLATION WILL SERVE: (.! RESIDENCE COMMERCIAL l OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEWFG CAPACITY gel tt OF CCMPARIMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal E OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS OF LINES LENGTH OF LIVES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY UNE It <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WFLL R FOUNDATION ft PROPERTY LINE '_R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH IT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYUNE_ it <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH R DEPTH 1t <br /> DISTANCE TO NEAREST WELL R FOUNOATIOH R PROPERTY LINE ft <br /> ❑ SEEPAGEPITS NUMBER WIDTx R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION ANDTHEWORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUAL-418t(2ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL LZW953-7UZUZ <br /> SIGNED TITLE Safety Director DAT <br /> I <br /> PAYMENT <br /> see attaC led ECEIVED <br /> EP <br /> 28 ?010 <br /> �RONMECOUNTY <br /> H DEpgRTMENT <br /> EPA TfEmr.US11 ONLY <br /> Application Accepted By �� ate Area / Employee ID* <br /> DA— <br /> Final Inspection By � .'- r�INDa[e ;A [I SPECIAL PERMIT-Approved by <br /> Character of Soli to Depth of 3 Ft: ..i / Pit/Sump Sol Charactor. <br /> COMMENTS De,ym 0-f-660AY <br /> PE SC Received Checkkf AmountPermit/ <br /> i Coda INFO 8 Cash Remitted bate, rviceRo uest0 Invoice# PertrIItID4 <br /> 0-75 1` ZIs <br /> -- <br /> 42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PER1Afi <br /> 4114;18 <br /> • �/l���'3 87 <br /> 7 <br />